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reforms and the various taxes that have been attacked on such as the insurance premium tax, the new fee that was announced for insurers who will be entering into exchanges, the medical device -- those are all going to be passed on to the users. that doesn't mean there aren't enormous potentials for figuring out how to provide care more efficiently for the future. we just have nothing now that should let us expect that that is going to happen. if we are lucky and figure out what works and figure out whether it is scaleable and how to make it part of the medicare program, all of that could change but to gauge the lower payments that are estimated for medicare over the course of this decade reflect lower payments to providers of services, not lower costs by most services to medicare beneficiaries. really important difference. >> is it fair to say -- did i understand correctly what you were saying, to be there really isn't a cost of lowering strategy that is available now? >> the only small items that are actually in the legislation are the ones that come to mind, the accountable care organ
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